Permit (6) CITY OF TIGARD ELECTRICAL PERMIT
1114 a COMMUNITY DEVELOPMENT Permit#: ELC2023-00648
Date Issued: 10/30/2023
T E GAR jD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S114AB13400
Jurisdiction: Tigard
Site address: 16225 SW 93RD AVE
Project: Kirch Subdivision: KNEELAND ESTATES NO.2 Lot: 113
Project Description: (5)branch circuits for kitchen and dining room remodel.
Contractor: PRO CIRCUIT ELECTRIC LLC Owner: KIRCH FAMILY TRUST
15846 SW UPPER BOONES FERRY RD BY KIRCH, RALPH E III &
LAKE OSWEGO, OR 97035 KIRCH, NATALIE L TRS
16225 SW 93RD AVE
TIGARD, OR 97224
PHONE: 971-563-8211 PHONE:
FAX: 503-266-1349
FEES
Quantity Description Date Amount
5 crt Branch Circuits wo/Purchase 10/30/2023 $85.86
Specifics: Service or Feeder
1 ea 12%State Surcharge- 10/30/2023 $10.30
Type of Use: Electrical
Class of Work:
Type of Const:
Occupancy Grp:
Total $96.16
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the
180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 throuoh AR 952-001-0090. You may obtain a co o e rules or direct questions to OUNC by callin.387 or 1.800.332.2344.
Issued By: Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC'N Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application l nit OFFICE i'SL ONLY
City of Tigard E I V Dates` . v , dim, • -411' ,<< -.0 - :1
II 't 13125 SW Hall Blvd.,Tigard,OR 9 plan Review
I Phone: 503.718.2439 Fax: 503.598.1960 Datc/B . "" ':ter l..•fI"" i
Inspection Line:
503.639.41
ITT
3 Ready Date/By:
7'1 C�n is i) Internet: www.tigard-or.gov75 t, ( Notified/Method: S.See pegent 2 for
V Sappkoeallafermatioe
TYPE OF w 0h I!GPO PLAN REVIEW
❑New construction -Addition/altt ,, •, Cicial .
t °n mot
f YY Please check all that apply(submit 1 sets of plans w/hems checked):
O Service or feeder 400 aegis or more Cl Building ova three stories.
❑Demolition 0 Other: where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
and 2-family dwelling 0 Commercial/mdustrial 0 Accessory building less to ground,or exceeds 14,000 p Commercial-use agricultural
❑Multi-family ❑Master builder �for all other installations. buildings.
e1: ❑FM pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 icy system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address:I(p 225 SIBAve_a15'. AV 100HP or more. ❑"A","E","1-2","1-3",
City/State/ZIP: D Slot or more residential units. y
Tag aid, 4 R 9�i 2 4 ❑Health-rare facilities. 0 Recaeatlonal vehicle parka.
Suite/bldg apt.#: Project name: .t v GSeN D Hazardous locations. 0 Supply voltage for more than
Cross street/directions to job site: li ❑Service or feeder 600 amps or more. 600 volts nominal.
(.44 g4. •FEE SCHEDULE
fwipt ea I Qty. I seer I fatal I
New residential single-or multi-family dwelling unit.
Subdivision: �t Lot#: Includes attached garage.
1,Tax map/parcel#: 2.S 114 A l S 4� Es.a d'lsq.St or less168.54 4
DESCRIPTION OF WORK Limited energy,sq.esft.or portion 33.92 ]
residential 75.00 2
(-, (with above sq.it.)
E r.A`.en Ctics+rlx ngi 1'Y�C�tM plCIC��r) Limited energy,multi-family
QY J t t i Me % J `tom residential(with above sq.ft.) 75.00 2
t" OWNER I N (] TENANT Renewable EnerrY 0 See Page 2
Services or feeders installation,alteration,and/or relocation
Name: . a m kx - E ' r. a. `,r G 200 amps or less 100.70 2
Address: I I 5 SW c1 3 t8 L 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Ti Q
City/State/ZIP: ap a 1 0 Q �p ^t1 f-.24 601 amps to 1,000 amps 301.04 2
Phone:(603) Frio— O5 6 p Fax:( ) Ova 1,000 amps or volts 55226 2
Temporary services or feeders installation,alteration,and/or
Email: ke1\<21 "Gh rJa to cnct:i c)lh relocation
Owner Installation:This installations-a being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 snips
125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
tia APPLICANT I ❑ CONTACT PERSON Branch circuits—new,alteration,or extension, r panel
1 A.Fee for branch circuits with
Business name: �, C, ,C i � t��, breach
circuit er fee, 7.42 r(7e 2
each Contact name:Sr�,n. .�i giver-c4(ems B.Fee for branch circuits without
�"'�" �''l J service or feeder fee,first 56.18 2
Address: % 5 515 Sw —7 4 `' Atte #Z. branch circuit
City/State/ZIP: Ti 4,f,th t�(Z Cl 2�.L! Each add'1 branch circuit 7.42 2
Phone: (�`q�1 SMiscellaneous(service or feeder not included)
(6j) Fax::( ) Each manuiacpvai or modular
dwelling,service and/or feeder 67.84 2
Email:SUALA.O.g gt s c—t-r tY1 scy. `�„„. .C��‘ Roc.1 only 67.84 2
CONTRACTOR� + Pump or irrigation circle 67.84 2
Business name:-pro (i' rtu+ lz c� ,.. L I—C. Sign or outline lighting 67.84 2
l
Address: ' Signal circuit(s)or limited-energy ❑ See Page 2 2
t 5S4 CO (,,p(3Pr.`Utx,tr,F'g Tv-jr,,A ad panel,alteration,or extension.
( Each additional inspection over allowable in any of the above
City/State/ZIP:
L C,L t.,->air , ( 1lQ G'i C)(a 2 Additional inspection(1 hr min) 66.25/hr
Phone:(CI 1() 543 S'a 2`t Fax:( ) investigation(1 hr min) 90.00/hr
Email: p m ice Q. 1 + Industrial plant(1 hr min) 78.18/hr
G\`CC t..s\�(X C. �►On Inspections for which no fee is
CCB Lie.: a •: Electrical Lei bpi Suprv.Lic.: � _5 specifically listed(1/2hr min) 90.00/hr
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,req.;, I Subtotal:
Print name: pi" s J'i() ^(A 40 r Date: (0 1 r3/23 ❑Plan Review Required(25%of permit fee):
State surcharge(12%ofpermh fie): 1 0 '
Authorized signature / TOTAL PERMIT FEE: 110 t I (0
This permit application expires if a permit is not obtained within 160
Print name:'�`fa_ �, — e S Date:a--I(_23 days after it has been accepted as complete.
' * Number of inspections allowed per permit
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